Non Operative Management of Isolated Blunt Liver Trauma: A Task of High Skilled Surgeons

Background: Liver is the most injured organ in abdominal trauma. The management of blunt liver trauma has markedly changed in the last three decades with a significant improvement in outcomes, due to improvements in diagnostic and therapeutic aids. This study details incidence, grades, causes, types and management of blunt isolated liver trauma in trauma patients admitted to Assiut and South Valley University Hospitals. Patients and Methods: All patients having blunt liver trauma were admitted, history taking, laboratory investigations and resuscitation were performed simultaneously along with ultrasound and CT scan as needed. Data of mechanism trauma, grade of liver injury, method of intervention (Operative or non-operative) and outcome were collected, tabulated and analyzed. Results: Total 174 cases were included in this study with diagnosis of isolated blunt hepatic injuries, mostly young patients were involved, and their mean age was found 24.19+14.65 years. The majority of patients were males 138 (79.31%). Operative management was adopted in 39 patients (22.41%), non-operative management adopted in 129 patients (74.13%), and 6 patients (3.45%) died during initial resuscitation. Most cases of liver trauma were found to be grade-III hepatic injury (41.1%). Chest infection was the commonest complication after surgical management. The mortality rate (12.1%) was significantly associated with severity of injury (grade IV and V). Conclusion: Non-operative management of isolated blunt liver trauma is feasible and safe in haemodynaically stable patient with grade I-III liver injury. Mortality in grades IV and V liver trauma is significantly high, so, early operative intervention is recommended in those patients.